The simple guide to claiming money back on pharmaceuticals

When you can claim for pharmaceuticals 

As an Australian resident with a current Medicare card or an overseas visitor from a country with a Reciprocal Health Care Agreement, you can access a list of pharmaceuticals, known as the Schedule of Pharmaceutical Benefits Scheme (PBS), at government-subsidised prices. 

However, there are also a wide number of drugs not available on the PBS list, which eligible Australian Unity members can claim money back on, if the drug: 

  • costs more than $41.00 (figure current as of 1 January 2020)
  • is dispensed by a registered pharmacist in a private practice 
  • is only available on prescription, listed on the Australian Register of Therapeutic Goods.
  • Australian Unity are only able to pay a benefit after you have paid an equivalent of the current Pharmaceutical Benefits Scheme contribution (currently $41.00).
When you can’t claim for pharmaceuticals 

You can’t claim money back if the drug is:

  • dispensed via prescription to hospital in-patients (these drugs are covered under your hospital cover)
  • used as a contraceptive
  • normally available over-the-counter without a script, even if it has been prescribed
How to make a claim on pharmaceuticals 

To claim money back on pharmaceuticals, use our normal extras claims options. Please make sure you accompany your claim with an official pharmacy receipt, which must show the script number, the name of the patient and the name of the drug.

In most cases, pharmacies now detail either (Private) or (Priv) on the receipt, which normally indicates that the script is Non-PBS and payable by private health insurance. 

 

 

Want to know more?
If you are uncertain about your level of pharmacy cover, call us on 13 29 39 and ask for a right cover check.  After listening to your concerns, we may be able to suggest an alternative cover that better suits your pharmacy coverage needs.